Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Sutton-Smith, Lynsey; Jutel, Annemarie

doi:10.4037/ccn2016420

Cited by 22 publications

(12 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As previously discussed, some patients were not able to be included in the CIWA‐Ar analysis because of the lack of available CIWA‐Ar assessments after the sedation medication was initiated. As described by Sutton and Judel, CIWA‐Ar scores are not able to be assessed in intubated patients because of the need for subjective symptom severity provided by the patients.…”

Section: Discussionmentioning

confidence: 99%

Use of Propofol Plus Dexmedetomidine in Patients Experiencing Severe Alcohol Withdrawal in the Intensive Care Unit

Love

Zimmermann

2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Alcohol abuse and alcohol withdrawal syndrome are major problems in the United States. This retrospective chart review assessed efficacy and safety of propofol plus dexmedetomidine used in combination as adjunctive therapy to benzodiazepines compared with either agent used alone in the treatment of severe alcohol withdrawal. Patients admitted to the intensive care unit and experiencing severe alcohol withdrawal between September 1, 2015 and September 30, 2018 were assessed for eligibility. Primary end points were change in the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA‐Ar) score and incidence of bradycardia and hypotension. The combination of propofol and dexmedetomidine was associated with a change in CIWA‐Ar score of −10.4 (95%CI −13.5 to −7.3) points compared with −4.7 (95%CI −6.6 to −2.8) points with propofol and −4.4 (95%CI −7.4 to −1.4) with dexmedetomidine (P = .21). Bradycardia was experienced by 11.1% of patients receiving the combination, 15.4% of patients receiving propofol, and 28.6% of patients receiving dexmedetomidine (P = .40). Patients receiving dexmedetomidine experienced hypotension at a rate of 21.4% compared with 22.2% of patients receiving the combination and 38.5% of patients receiving propofol (P = .08). Patients in the combination group also had a shorter length of hospital and intensive care unit stay and shorter time to extubation when compared with the propofol and dexmedetomidine groups. Although no statistical significance was found, the combination was associated with better efficacy and safety outcomes than produced by either agent used alone.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of Propofol Plus Dexmedetomidine in Patients Experiencing Severe Alcohol Withdrawal in the Intensive Care Unit

Love

Zimmermann

2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…The concept of under treatment is difficult to exclude: in the Booth and Blow (1993), Lee et al (2005) and Monte et al (2010) studies were no tools to influence alcohol withdrawal treatment were evident, an omission not found in the studies were previous DTs and ARS were not associated with DTs and ARS development (Mennecier et al , 2008; Eyer et al , 2011). The concept of poor alcohol management in the acute hospital is recognised (McKeon et al , 2008; Swift et al , 2010; Sutton and Jutel, 2016) and difficult to discount in the systematic literature review where the majority of studies investigated DTs within alcohol detoxification treatment.…”

Section: Discussionmentioning

confidence: 99%

Severe alcohol withdrawal syndrome: review of the literature

Benson

Roberts

McCallum

et al. 2019

DAT

View full text Add to dashboard Cite

Purpose The purpose of this paper is to identify published literature from a general hospital setting that may highlight variables implicated in the development of severe alcohol withdrawal syndrome (SAWS) in patients who have alcohol dependence syndrome (ADS). Design/methodology/approach A systematic literature review was carried out using the electronic databases: MEDLINE, Medline in Process, Cinahl, Embase and PsycINFO from 1989 to 2017. The focus of this search was on English language studies of individuals over 16 years admitted to general hospital with ADS, delirium tremens (DTs), alcohol-related seizure (ARS) or alcohol withdrawal syndrome (AWS). Findings Of the 205 studies screened, eight met the criteria for inclusion. Six studies were quantitative retrospective cohort and two were retrospective case-control. Six studies investigated risk factors associated with DTs, one examined SAWS and one alcohol kindling. Descriptive analysis was performed to summarise the empirical evidence from studies were 22 statistically significant risk factors were found; including the reason for admission to hospital, daily alcohol consumption, previous DTs and prior ARS. The last two factors mentioned appeared in two studies. Research limitations/implications Further research should consider the quality and completeness of the alcohol history data and competence of staff generating the data in retrospective studies. Originality/value The paper suggests that the factors linked to SAWS development from the literature may not fully explain why some individuals who have ADS develop SAWS, and others do not.

show abstract

“…A consequence of ADS is the development of AWS on cessation of alcohol use. AWS spans a spectrum that ranges from mild, requiring minimal intervention to severe, where hospital admission and pharmacological treatment are required (Sutton and Jutel, 2016). Although there are tools for the treatment of AWS, their purpose is for the identification and treatment of those at high risk of SAWS (Maldonado et al, 2015;Pecoraro et al, 2013;McPherson et al, 2012;Dolman and Hawkes, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, as a determinant of SAWS, the measure of ADS severity is paramount as a starting point to understanding risk (Stockwell et al, 1983). Subsequently, none of the studies reviewed used a tool to record the severity of the person's ADS in an environment where poor alcohol assessment is known (Sutton and Jutel, 2016;Stehman and Mycyk, 2013;Forsythe and Lee, 2012). Consequently, it is difficult to exclude the prospect that the results and low prevalence of ADS may be as reflective of the quality of assessment data as their association with SAWS risk.…”

Section: Discussionmentioning

confidence: 99%

“…AWS and ADS span a spectrum that range from mild to severe, where mild withdrawal requires minimum intervention, and severe alcohol withdrawal syndrome (SAWS) that includes alcohol-related seizures (ARS) and delirium tremens (DT's) hospital admission (Sutton and Jutel, 2016;Feeney et al, 2015;Passetti et al, 2008). Although SAWS is experienced by approximately 10 per cent of people, emergency department physicians are under pressure to see patients and make decisions quickly (Vardy et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Development of an alcohol withdrawal risk stratification tool based on patients referred to an addiction liaison nursing service in Glasgow

Benson

McPherson

McCallum

et al. 2019

DAT

View full text Add to dashboard Cite

Purpose The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department. Design/methodology/approach A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population. Findings The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively. Research limitations/implications The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score. Practical implications The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life. Originality/value The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.

show abstract

Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Cited by 22 publications

References 69 publications

Use of Propofol Plus Dexmedetomidine in Patients Experiencing Severe Alcohol Withdrawal in the Intensive Care Unit

Use of Propofol Plus Dexmedetomidine in Patients Experiencing Severe Alcohol Withdrawal in the Intensive Care Unit

Severe alcohol withdrawal syndrome: review of the literature

Development of an alcohol withdrawal risk stratification tool based on patients referred to an addiction liaison nursing service in Glasgow

Contact Info

Product

Resources

About